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rLVx VI-I-K-1: USt: y f99a APPLICATION FOR SANITATION PERMIT Permit No. ....................... ----------------- ---------- ------ --------------------- (Complete in Duplicate) ------.--- This Permit Expires f Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION...-__-.- _-..- �--�--•��Q---- � Owners Name--------------- � ----- - - -------------------- ----------Phone------------------------------------ Address---------------------------- ------ -----• - Address-----------------•---------- w .r Jl7 .- Contractor's Name--- ----- Ye_8---------------------------- Phone --- ----- Installation will serve: Residence parfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -Number of bedrooms ._ Number of baths ---yLot size -- - --. --_f--- -_ ----------------- Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Tabl�aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: (If yes,date--------------------) No El New Construction: Yes ❑ No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E Septi Tank: Distance-from'riearest'wel!_ _ �/��-Distan f a o�ynd _._,K.Material --.Q �-_-_ hh f ' No. of compartments--�Ct.--.--._______.--Size- -_--_-_--�JLiquid depth_--Z"F----_--.__.Ca acit �yQ <�s p Dispos I Field: Distance from nearest well.��+.I4Q._Distance from foundation--ZA'o Number of lines -_.---Distance to nearest lot line--- -- ---�-- �- ' --- --- -- Length of each line---Tp-�--- -_----.Width of french--A-- Type of filter materia Rep /f filteeamatrial-----1 � �otal,length---------------- - -- --------- 0 Seepa e Pit: Distance to nearest weiLDJi! _-Distanee.fro _ foundation_--- lP--------.Distance to nearest igi line------ d-- ""Linin material-- - Diameter Number of pits----- £- g Size: ._ -F.JI-_-------Depth- r - -------------- "V Cesspool: Distance from nearest 4e�l__,-----__-----_Distance from f�ndation.-..--t-___-_-Lining materiel-------------------------------- ---�- ❑ Size: Diameter s Depfh .- -- ------- ------ ------------Liquid Capacity------------------ ------gals. Privy: Distance from nearest well_s ---- ---------------.Distance from ndarest building- -- --------------------------- -- ❑ Distance to nearest lot fine--* `b -------------- -- ---------------- ---------� s Remodeling and/or repairing (describe):--- _-_____--- «.,. f --- - - I----- ------ ---- ------------ -----------------•------------- N ------------ ------------------------------------------------------------ ----------------------- ------------------------------------ ----. ------------ ------------- --------- �..�.._.... _..e.a..� I hereby cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St 1 w and rules and regulations of the San Jo quin Loca ealth District. _W By:(Signed)----- ----- ------- --- -'""'{- Contractor) BY: - --------- --- --- ------- : (Piot plan, showing size of lot, location of system in relation wells, building etc., can lle placed on reverse side). FOR'DEPARTMENT--USI ONLY APPLICATION ACCEPTED BY -- DATE--- REVIEWED �. --.:. -- DATE UILDING PERMIT ISSUEQ. ---- ----- - ------ ---------------------------------------- ------------------ --__--_ - . - ---------------- -- -/---- --------- DATE.-.------ Alterations and/or recommendations: _ ----------- ------x-77 -- -----:��.�.c-�-- •--•--4 - ,car ' f� �-----��.�-------- `'�--- i-- •�,�s.�.c-- -----�'r��,-----��,sr-.ems---- _0 ----------------------•------------ ----------- ---- ' - ---------------------- ----------------- ---- FINAL INSPECTION BY:- bate �� ^r ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi;California Manteca,California Tracy,California F.P.CO.